http://hdl.handle.net/1956/982 Search the Channel search http://bora.uib.no/simple-search http://hdl.handle.net/1956/2356 Title: Meeting students’ and supervisors’ expectations : findings from a pilot study done at Centre for International Health, University of Bergen <br/> <br/>Authors: Costea, Daniela Elena Wed, 29 Aug 2007 12:34:32 GMT http://hdl.handle.net/1956/2267 Title: Nosocomial outbreak of neonatal Salmonella enterica serotype Enteritidis meningitis in a rural hospital in northern Tanzania <br/> <br/>Authors: Vaagland, Hogne; Blomberg, Bjørn; Krüger, Carsten; Naman, Naftali; Jureen, Roland; Langeland, Nina <br/> <br/>Abstract: Background: Clinicians at Haydom Lutheran Hospital, a rural hospital in northern Tanzania noted an unusually high case-fatality rate of pediatric meningitis and suspected an outbreak of an unknown agent or an organism resistant to the empirical therapy. Methods: We established a provisional microbiology laboratory to investigate the suspected outbreak. Blood and spinal fluid specimens were taken from children below the age of seven years with suspected meningitis. The blood and spinal fluid specimens were inoculated in commercial blood culture bottles and locally prepared Thayer-Martin medium in slanted tubes, respectively. The bacterial isolates were sent to Norway for further investigation, including susceptibility testing and pulsed-field gel-electrophoresis (PFGE). Results: Among 24 children with suspected meningitis and/or septicemia, five neonates had meningitis caused by Salmonella enterica serotype Enteritidis, all of whom died. Two children had S. Enteritidis septicemia without meningitis and both survived. Genotyping with PFGE suggested a clonal outbreak. The salmonella strain was resistant to ampicillin and sensitive to gentamicin, the two drugs commonly used to treat neonatal meningitis at the hospital. Conclusion: The investigation reminds us that nontyphoidal salmonellae can cause meningitis associated with very high case-fatality rates. Resistance to multiple antimicrobial agents increases the risk of treatment failure and may have contributed to the fatal outcome in all of the five patients with salmonella meningitis. The investigation indicated that the outbreak was nosocomial and the outbreak subsided after hygienic measures were instituted. Establishing a provisional microbiological laboratory is a valuable and affordable tool to investigate and control outbreaks even in remote rural areas. Thu, 13 Sep 2007 22:58:59 GMT http://hdl.handle.net/1956/2266 Title: Surveillance of antimicrobial resistance at a tertiary hospital in Tanzania <br/> <br/>Authors: Blomberg, Bjørn; Mwakagile, Davis S. M.; Urassa, Willy K.; Maselle, Samwel Y.; Mashurano, Marcellina; Digranes, Asbjørn; Harthug, Stig; Langeland, Nina <br/> <br/>Abstract: Background: Antimicrobial resistance is particularly harmful to infectious disease management in low-income countries since expensive second-line drugs are not readily available. The objective of this study was to implement and evaluate a computerized system for surveillance of antimicrobial resistance at a tertiary hospital in Tanzania. Methods: A computerized surveillance system for antimicrobial susceptibility (WHONET) was implemented at the national referral hospital in Tanzania in 1998. The antimicrobial susceptibilities of all clinical bacterial isolates received during an 18 months' period were recorded and analyzed. Results: The surveillance system was successfully implemented at the hospital. This activity increased the focus on antimicrobial resistance issues and on laboratory quality assurance issues. The study identified specific nosocomial problems in the hospital and led to the initiation of other prospective studies on prevalence and antimicrobial susceptibility of bacterial infections. Furthermore, the study provided useful data on antimicrobial patterns in bacterial isolates from the hospital. Gram-negative bacteria displayed high rates of resistance to common inexpensive antibiotics such as ampicillin, tetracycline and trimethoprim-sulfamethoxazole, leaving fluoroquinolones as the only reliable oral drugs against common Gram-negative bacilli. Gentamicin and third generation cephalosporins remain useful for parenteral therapy. Conclusion: The surveillance system is a low-cost tool to generate valuable information on antimicrobial resistance, which can be used to prepare locally applicable recommendations on antimicrobial use. The system pinpoints relevant nosocomial problems and can be used to efficiently plan further research. The surveillance system also functions as a quality assurance tool, bringing attention to methodological issues in identification and susceptibility testing. Sun, 10 Oct 2004 22:58:59 GMT http://hdl.handle.net/1956/2265 Title: Antimicrobial resistance in bacterial infections in urban and rural Tanzania <br/> <br/>Authors: Blomberg, Bjørn <br/> <br/>Abstract: Infectious diseases cause one in every six deaths worldwide. Antimicrobial drugs have helped dramatically in curing patients suffering from bacterial infections. However, emerging antimicrobial resistance in bacteria threatens to undermine the management of bacterial infections. Developing countries have greater burden of infectious diseases. A number of factors, which may promote antimicrobial resistance such as availability of antimicrobials without prescription, use of counterfeit or substandard antimicrobial drugs, suboptimal hygiene, immunosuppression due to malnutrition or HIV, may be more frequent in developing countries. At the same time, consequences of antimicrobial resistance may be felt harder in resource-poor settings, since second-line antimicrobial drugs for resistant bacteria may be unavailable or unaffordable. There are many unresolved questions regarding antimicrobial resistance in general, including regarding its impact on patient outcome. In Sub-Saharan, some studies on antimicrobial resistance have been done, but, by and large, the issue has received far too little attention. We set out to improve available antimicrobial susceptibility data in Tanzania. We implemented a free-of-charge computerized software (WHONET) for resistance surveillance in the University Teaching Hospital in Dar es Salaam. This exercise showed that resistance surveillance is feasible in the setting and provided useful data on antimicrobial resistance. The surveillance data indicated high rates of resistance to common antibiotics in Gram-negative bacteria. We performed a prospective, observational cohort study of bloodstream infections in 1828 admissions of children with fever or suspected serious infection at the hospital. We performed blood culture, malaria testing and HIV testing and collected clinical data from the study subjects. The study showed that a disturbingly high proportion of Gram-negative bacteria produced extended-spectrum beta-lactamases (ESBL), with prevalent genotypes being TEM-63, SHV-12 and CTX-M 15. The ESBL-producing bacteria had a high rate of resistance to almost all other available drugs, except for ciprofloxacin, and bloodstream infection caused by these multiresistant bacteria were associated with extremely high case-fatality rates. The study showed that inappropriate treatment due to antimicrobial resistance, as well as malnutrition and HIV-infection, were risk factors for death in children admitted with bloodstream infections. We investigated an outbreak of pediatric / neonatal meningitis at Haydom Lutheran Hospital, finding that Salmonella serovar Enteritidis, resistant to ampicillin and susceptible to gentamicin, was the cause of the outbreak. Although the numbers were small, the case-fatality rate for meningitis caused by these organisms was 100% (5/5). Antimicrobial resistance varies greatly from one geographical area to another. Thus, data obtained at major hospitals in urban centers may not be representative for the whole country. We analyzed the antimicrobial susceptibilities of isolates of uropathogenic bacterial obtained from the urine of pregnant women in a rural area in Northern Tanzania. This study indicated that there is less antimicrobial resistance in E. coli isolates from this rural area than in isolates from the commercial capital, Dar es Salaam. In formulating guidelines for antimicrobial use this possible rural-urban difference should be taken into account. For some of the bacteria carrying resistance traits for multiple antimicrobials, there are actually no good alternative drugs available. Based on the findings of these studies, we recommend sober, rational use of antimicrobial drugs, restrictions on sale and use of antimicrobials, and attention to hygiene. Tue, 15 May 2007 22:58:59 GMT http://hdl.handle.net/1956/2214 Title: Time-dependent clock gene expression in mouse and human stem and progenitor cells <br/> <br/>Authors: Tsinkalovsky, Oleg <br/> <br/>Abstract: Time is a fundamental part of all biological processes. During the whole process of evolution, living cells and organisms had to adapt to cyclic variations in the environment. In particular, the light and temperature conditions varied with day and night and with the seasons. The cellular functions and behavior in organisms were regulated according to their daily needs and provision of optimal conditions for survival. Time functions in cells are of two kinds. One is the cyclic variation, where the same events come back with regular intervals. Thereby, cellular adaptation occurs in a cyclic manner. The second way is longitudinal time regulation. From conception on, the development of organs occur sequentially and strictly coordinated in time until a mature fetus is ready for delivery. The periods of gestation, infant, growth and maturity, as well as aging, are strictly regulated in all higher organisms. Total life span is also rather constant within each species, although there are differences of many fold between short-lived and long-lived species. Thus, all the different longitudinal time periods in the life within a species are strictly coordinated to each other and are in concordance with total life span. Time regulation in single cells occurs at shorter intervals, both with cyclic and noncyclic variations. The oscillations may be down to a few seconds or even parts of seconds, such as nerve pulses. Heartbeat in higher organisms usually occurs as a rhythm of about one second or less, respiratory rhythm is slower, while the rhythm of the blood pressure is according to day and night. As a result, many types of time regulation and adaptation are occurring simultaneously in the same organism. Until a few years ago, the study of such time keeping was largely confined to the observation of phenomena from the outside and with mainly a descriptive approach. This has been replaced by a deeper understanding of the underlying biology and regulatory mechanisms at the genetic level (for recent review see Koukkari and Sothern, 2006b). This thesis deals with the hematopoietic system in mice and in men, a highly adaptable tissue with a high cell turnover and many different functions that cover all parts of the body. It is therefore no wonder that time keeping is an important part of the regulatory circuits. The main emphasis of this thesis is on the elucidation of local clock functions in cells of different stage of maturation, and discussion on how the molecular clock in bone marrow (BM) is unique compared to other tissues, as well as different between species. Thu, 29 Mar 2007 22:58:59 GMT http://hdl.handle.net/1956/2213 Title: In situ localization of interferons in psoriatic lesions <br/> <br/>Authors: Livden, J. K.; Nilsen, Rune; Matre, R. <br/> <br/>Abstract: An indirect immunofluorescence technique, using murine monoclonal antibodies (MoAbs) against human IFN- and human IFN- was used to study IFNs in cryostat sections from psoriatic skin lesions. The IFNs were more pronounced in sections from highly active psoriasis than in sections from stationary psoriasis. In highly active psoriatic lesions IFNs- was localized to keratinocytes in stratum basale, to some epidermal dendritic cells, probably Langerhans cells, and to some mononuclear cells in dermis. IFN- was usually not detected in sections from stationary psoriasis. IFN- was localized to stratum corneum, to keratinocytes around microabcesses and to mononuclear cells in the dermal cell infiltrates, predominantly in highly active psoriatic lesions. Both IFN- and IFN- were localized to some endothelial cells in the papillary dermis. The MoAbs did not stain sections from unaffected skin from patients with psoriasis or sections from healthy individuals. The findings indicate that the IFN system in the skin may be of significance in the pathophysiology of psoriasis. Thu, 28 Sep 1989 22:58:59 GMT http://hdl.handle.net/1956/2212 Title: Low adherence to exclusive breastfeeding in Eastern Uganda: A community-based cross-sectional study comparing dietary recall since birth with 24-hour recall <br/> <br/>Authors: Engebretsen, Ingunn Marie S.; Wamani, Henry; Karamagi, Charles A. S.; Semiyaga, Nulu; Tumwine, James K.; Tylleskär, Thorkild <br/> <br/>Abstract: Background: Exclusive breastfeeding is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity. It also seems to lower HIV-1 transmission compared to mixed feeding. We studied infant feeding practices comparing dietary recall since birth with 24-hour dietary recall. Methods: A cross-sectional survey on infant feeding practices was performed in Mbale District, Eastern Uganda in 2003 and 727 mother-infant (0–11 months) pairs were analysed. Four feeding categories were made based on WHO's definitions: 1) exclusive breastfeeding, 2) predominant breastfeeding, 3) complementary feeding and 4) replacement feeding. We analyzed when the infant fell into another feeding category for the first time. This was based on the recall since birth. Life-table analysis was made for the different feeding categories and Cox regression analysis was done to control for potential associated factors with the different practices. Prelacteal feeding practices were also addressed. Results: Breastfeeding was practiced by 99% of the mothers. Dietary recall since birth showed that 7% and 0% practiced exclusive breastfeeding by 3 and 6 months, respectively, while 30% and 3% practiced predominant breastfeeding and had not started complementary feeding at the same points in time. The difference between the 24-hour recall and the recall since birth for the introduction of complementary feeds was 46 percentage points at two months and 59 percentage points at four months. Prelacteal feeding was given to 57% of the children. High education and formal marriage were protective factors against prelacteal feeding (adjusted OR 0.5, 0.2 – 1.0 and 0.5, 0.3 – 0.8, respectively). Conclusion: Even if breastfeeding is practiced at a very high rate, the use of prelacteal feeding and early introduction of other food items is the norm. The 24-hour recall gives a higher estimate of exclusive breastfeeding and predominant breastfeeding than the recall since birth. The 24-hour recall also detected improper infant feeding practices especially in the second half year of life. The dietary recall since birth might be a feasible alternative to monitor infant feeding practices in resource-poor settings. Our study reemphasizes the need for improving infant feeding practices in Eastern Uganda. Wed, 28 Feb 2007 22:58:59 GMT http://hdl.handle.net/1956/2209 Title: High prevalence of respiratory symptoms among workers in the development section of a manually operated coal mine in a developing country : a cross sectional study <br/> <br/>Authors: Mamuya, Simon H. D.; Bråtveit, Magne; Mashalla, Yohana; Moen, Bente E. <br/> <br/>Abstract: Background: Few studies of miners have been carried out in African countries; most are from South Africa, where the working conditions are assumed to be better than in the rest of Africa. Several studies have focused on respiratory disorders among miners, but development workers responsible for creating underground road ways have not been studied explicitly. This is the first study assessing the associations between exposure to dust and quartz and respiratory symptoms among coal mine workers in a manually operated coal mine in Tanzania, focusing on development workers, as they have the highest exposure to coal dust. Methods: A cross-sectional study was carried out among 250 production workers from a coal mine. Interviews were performed using modified standardized questionnaires to elicit information on occupational history, demographics, smoking habits and acute and chronic respiratory symptoms. The relationships between current dust exposure as well as cumulative respirable dust and quartz and symptoms were studied by group comparisons as well as logistic regression. Results: Workers from the development group had the highest dust exposure, with arithmetic mean of 10.3 mg/m3 for current respirable dust and 1.268 mg/m3 for quartz. Analogous exposure results for mine workers were 0.66 mg/m3 and 0.03 mg/m3, respectively; and for other development workers were 0.88 mg/m3 and 0.10 mg/m3, respectively. The workers from the development section had significantly higher prevalence of the acute symptoms of dry cough (45.7%), breathlessness (34.8%) and blocked nose (23.9%). In addition, development workers had significantly more chronic symptoms of breathlessness (17.0%) than the mine workers (6.4%) and the other production workers (2.4%). The highest decile of cumulative exposure to respirable dust was significantly associated with cough (OR = 2.91, 95% CI 1.06, 7.97) as were cumulative exposure to quartz and cough (OR = 2.87, CI 1.05, 7.88), compared with the reference consisting of the group of workers with the lowest quartile of the respective cumulative exposure. Conclusion: The development workers in a coal mine had more acute and chronic respiratory symptoms than the mine and the other production workers. In addition, there was an association between high cumulative coal dust and respiratory symptoms. Wed, 31 Jan 2007 22:58:59 GMT